冠状动脉轻中度病变血管内超声显像与冠状动脉造影对比分析

Intravascular ultrasound study of angiographically mildly diseased coronary arteries

目的 :经血管内超声 (IVUS)进一步评价冠状动脉 (冠脉 )造影 (CAG)对轻中度冠脉病变诊断的准确性。方法 :对 10 4例临床诊断为冠心病 (CHD)或可疑CHD的患者 ,均详细询问病史 ,行心电图、超声心动图、CAG及IVUS检查。数据经t检验 ,χ2 检验及相关性检验。结果 :①临床症状及心电图改变 :典型心绞痛 5 7例 ,不典型心绞痛 4 7例。心电图呈缺血性ST T改变 6 2例 ,心房颤动 8例 ,右束支传导阻滞 4例 ,室性心律失常 10例 ,正常心电图 2 0例。②IVUS及CAG结果比较 :10 4例共 113处血管病变 ,CAG示面积狭窄为 0～ 85 .12 (5 8.0 7±17.4 2 ) % ,IVUS示面积狭窄为 0～ 92 .34(74 .0 0± 14 .91) % (P <0 .0 5 )。病变长度CAG为 6～ 4 0 (14 .12±10 .0 8)mm ,IVUS为 4～ 5 5 (2 1.16± 2 5 .17)mm ,(P <0 .0 5 )。CAG示 8例钙化性斑化 ,IVUS示 4 7处钙性斑块(P <0 .0 1)。CAG示偏心性斑块 13处 ,IVUS示偏心性斑块 73处 (P <0 .0 1)。③IVUS与CAG面积狭窄程度呈正相关 (r =0 .5 2 ,P <0 .0 1)。结论 :CAG显示的血管病变程度明显轻于IVUS ,漏诊率为 8%。CAG对钙化性病变检出率亦明显低于IVUS ,低估病变的程度 ,而IVUS可弥补这一不足。但CAG仍是检测CHD较普遍的方法 ,对心绞痛和心电图有缺血性ST T改变而CAG正常者 ,

Objective:To evaluate the effect of intravascular ultrasound imagingon the diagnosis of coronary artery disease (CAD).Method:The study involved 104 patients with CAD or snspected CAD. 73 men and 31 women, aged 36～77 years ( 61.68 ± 9.98 years). Electrocardiography, Echocardiography, coronary angiogram (CAG) and Intravascular ultrasound imaging (IVUS) were taken. The findings of CAG and IVUS were compared by chi square analysis and test and correlations.Result: A total of 113 vesseles segments in 104 patients were studied. Mean maximal arterial area narrowing measured by IVUS was( 74.00 ± 14.91 )% (rang 0% to 92.34 %), compared with that by quantitative anglography ( 58.07 ± 17.42 )%(rang 0～ 85.12 %, P< 0.05 ). The mean length was( 21.16 ± 25.17 mm by ultrasound, and ( 14.12 ± 10.08 )mm by guantitative angiography (P< 0.05 ).Angiography detected calcium plaques in 8 of 113 lesions, and IVUS detected calcium plaques in 47 of 113 (P< 0.01 ). There were eccentric plaques in 13 of 113 lesions by angiogrphy, and in 73 of 113 lesions by ultrasound (P< 0.01 ). Conclusion:There is a significant understimantion of mildly diseased coronary arteries by quantitative angiography. The false negative rate is 8%. If patients with angina associate with normal CAG, should take IVUS.